The introduction of surfactant therapy for neonatal respiratory distress syndrome, RDS, has red-uced mortality and morbidity for preterm infants. However, a substantial gap remains between the practices supported by findings of high quality research and those in routine clinical use. In particular, although the evidence supports prophylactic administration of surfactant in the delivery room for infants at high risk for RDS and supports the early administration of surfactant to infants with established RDS, relatively few infants currently receive delivery room treatment and many infants with RDS receive treatment that is delayed for several hours after birth. The aim of this proposal is to evaluate a coordinated multi-faceted intervention designed to close this gap by promoting the translation of research into practice. The components of the intervention are: (1) Performance feedback and peer comparisons of surfactant practices and patient outcomes using information from the Vermont Oxford Network Database; (2) A specially designed review of the evidence on surfactant therapy based on the Cochrane Database of Systematic Reviews; and (3) Training and support in evidence-based quality improvement which stresses 4 key habits of clinical improvement (change, evidence-based practice, practice as process and collaborative learning). We will conduct a randomized controlled trial of this intervention determine whether it (a) increases the proportion of preterm infants less than 30 weeks gestation who receive surfactant in the delivery room. (b) decreases the median time at which surfactant is first administered. (c) decreases mortality, and (d) influences other delivery room practices and in-hospital morbidity. In this trial 55 institutions will be assigned to the intervention group and 55 to the control group. We will also identify and describe those patient, provider and hospital characteristics which influence the administration and the timing of surfactant therapy and those which modify the effects of the intervention. This research project will be conducted by a public-private consortium formed by The University of Vermont, Burlington, The University of Alabama, Birmingham and the Vermont Oxford Network, a private non-profit corporation with over 310 member institutions participating in its existing Database and other activities.